Enucleation Is a Feasible Procedure for Well-Differentiated pNEN-A Matched Pair Analysis.

Abstract

Simple SummaryNeuroendocrine neoplasms of the pancreas (pNEN) are rare malignancies with an increasing incidence rate. Optimal treatment strategies for non-functional and well-differentiated tumors in particular are still controversially discussed. Enucleation and formal oncological resection of pNEN are well-established operative treatment strategies. However, the risk of metastases requiring radical formal resection has to be weighed against the risk of overtreatment and potentially higher postoperative complication rates, especially in cases of well-differentiated pNEN, which carry a lower risk for the development of metastases in the future. Thus, this study compared enucleation and formal resection for well-differentiated non-functional pNEN. Postoperative complication rates and overall as well as disease-free survival were similar in the cohorts studied. Postoperative diabetes was developed significantly less often after enucleation. Thus, enucleation is a safe surgical procedure with good long-term outcomes for a selected group of patients.The extent of surgical resection in the treatment of pancreatic neuroendocrine neoplasms (pNEN) is still controversial. This study aimed to evaluate the outcomes of enucleation for well-differentiated non-functional (nf) pNEN. Patients undergoing enucleation (2001–2020) were analyzed. Clinicopathological parameters, perioperative outcomes and survival were assessed. The analysis was performed as a nested case-control study and matched-pair analysis with formal resection. Sixty-one patients undergoing enucleation were identified. Compared to patients undergoing formal resection, enucleation was associated with a significantly shorter median length of operative time (128 (IQR 95–170) versus 263 (172–337) minutes, p < 0.0001) and a significantly lower rate of postoperative diabetes (2% versus 21%, p = 0.0020). There was no significant difference in postoperative pancreatic fistula rate (18% versus 16% type B/C, p = 1.0), Clavien−Dindo ≥ III complications (20% versus 26%, p = 0.5189), readmission rate (12% versus 15%, p = 0.6022) or length of hospital stay (8 (7–11) versus 10 (8–17) days, p = 0.0652). There was no 30-day mortality after enucleation compared to 1.6% (n = 1) after formal resection. 10-year overall survival (OS) and disease-free survival (DFS) was similar between the two groups (OS: 89% versus 77%, p = 0.2756; DFS: 98% versus 91%, p = 0.0873). Enucleation presents a safe surgical approach for well-differentiated nf-pNEN with good long-term outcomes for selected patients.